Saturday, May 08, 2021

Your embryo is safe in your uterus - like a pearl in an oyster [Video]

 

Watch more such videos and updates about IVF on our Youtube Channel

Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.

Friday, May 07, 2021

Tubal (ectopic) pregnancy - so near and yet so far ! [Video]


 Watch more such videos and updates about IVF on our Youtube Channel


Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.


Thursday, May 06, 2021

The Paradox of Unexplained Infertility - Treatment is Easier than Diagnosis! [Video]

 


Watch more such videos and updates about IVF on our Youtube Channel


Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.


Wednesday, May 05, 2021

The endometrium and infertility - what every infertile couple needs to know about the uterine lining


Watch more such videos and updates about IVF on our Youtube Channel
 

Need help? We provide a second opinion on all infertility issues. Please send us your medical details by filling in the form at https://www.drmalpani.com/free-second-opinion so that we can guide you better.


Thursday, April 29, 2021

How we check if your frozen Blastocysts are live before transferring them ? - Dr. Sai, Chief Embryologist, Malpani Infertility Clinic Pvt. Ltd.


We routinely use Vitrification Technique  to rapidly freeze  Blastocysts for all our Patients.

When you come back for your Embryo Transfer ,  we thaw 1 blastocyst at a time,  and then transfer this back to your uterus. Thawing and transferring just 1 blastocyst allows us to extend the number of chances that you have to get pregnant with just one fresh Egg Collection and ICSI/IVF procedure. This increases your cumulative conception rate, and maximize your chances of getting pregnant.

Freezing (Vitrifying ) Blastoycsts are often considered challenging due to their Size, Structure and presence of Blastocoelic Cavity.

We have been vitrifying Blastocysts for many years now , and we routinely get a 100% Survival rate when we thaw them

When we freeze, the Expanded blastocysts are artificially collapsed using a laser pulse , to remove water from the blastocyst. This dehydration process is important as it Eliminates the risk of ice crystal formation completely, which can harm the cells . 




When we artificially collapse the blastocyst by giving a laser pulse between the 2 trophectoderm cells, the water comes out and all the cells shrink, which makes the vitrification process easier as it reduces the exposure time to the cryopectants.

Hence , when we vitrify the blastocysts , they are usually in a collapsed state during cryostorage . When we thaw them, they remain collapsed during the thawing process and then slowly re-expand with few hours of incubation post thaw.




As you can see in the picture, the blastocyst which was fully expanded before freezing, was artificially collapsed before being vitrified. It remained collapsed post thawing . We then allowed it to remain in culture in the incubator at 37 C.  During this time, it expanded back fully after a few hours of incubation. The re expansion usually takes about 1 hour. but usually the blastocysts are incubated for 3-4 hours before transferring them, to allow them to recover from the process of thawing.

The fact that the blastocyst has re-expanded is convincing proof that these cells and viable, and this is a healthy blastocyst, which has a good chance of implanting. Today, sadly many clinics fool patients by transferring blastocysts which have died after the thaw. Please don’t let your doctor fool you !




 










Wednesday, April 28, 2021

IVF Video - How IVF labs cheat patients by issuing wrong semen analysis reports


 

The easy shortcut to finding the right IVF clinic

 



IVF patients know that one of the most important decisions they need to make is how to find the right IVF Clinic .

This is a simple 3-step process . It’s tempting to take shortcuts and go to the nearest clinic, or the cheapest one, but this can be dangerous !

First, you need to use your head and deploy Information Therapy, so you understand your medical diagnosis, and what your treatment options are. Do you need ICSI ? TESA ? donor eggs ? Please don’t underestimate your own intelligence – you are smart, and if you don’t understand what the doctor is saying, this means the doctor is too dumb to explain it in simple language !

You then need to confirm the clinic provides this treatment. You can easily find this information online, or by email or a phone call, so use these tools to create a shortlist.

The next step is harder. You need to use your heart , so you can judge which of the doctors you have listed is right for you. This is where your gut feeling and intuition become important !

The doctor who was right for your friend may not be right for you – one size cannot fit all !

Let’s see a real life example of how this works out.

Start by emailing the clinic and see how quickly they respond to your emails. The other test of their professionalism is to phone the clinic, and assess how helpful the secretary is. Good doctors hire good receptionists, who treat patients with respect !

You only need to find out the answer to a single medical question -  do they routinely provide photos of embryos to all their patients , and whether they do only blastocyst transfers . If they refuse to answer this question, this in itself is a Red Flag , and you should definitely stay away from the clinic ! If the receptionist doesn’t know what a blastocyst is , this means the clinic is not a good one , because they haven’t invested in educating their staff.

You need to short list at least two IVF clinics , and then do a consultation with both. Interview the doctor , so you can judge if the doctor will treat you with respect . Is the chemistry between you and the doctor good ?

Thus, by checking both the doctor’s competence as well as whether you like the way he thinks and reassures you, you will be able to choose the clinic which is right for you. Please don’t let someone else make this decision for you

 

Thursday, April 22, 2021

How IVF clinics fool patients by transferring dead embryos


 A patient who had just failed an IVF cycle asked me for a second opinion

I asked her to share the photos of her embryos, and this is what she emailed me

These embryos are clearly dead. The cells are dead , dark and necrotic. It has arrested and is not going to develop any further.

The thawing process has killed the blastocyst, perhaps because the embryologist was not skilled enough to freeze embryos well.

However, instead of telling the patient the truth, the doctor lied, and transferred these dead blastocysts back to the uterus, in order to make money.

And IVF doctors can get away with this kind of malpractice because patients don't know enough to be able to ask questions.

At least this doctor shared embryo photos.

The vast majority of IVF clinics don't even bother to do this !

This is why many patients continue to suffer from failed IVF cycles

Sunday, April 18, 2021

IVF Video . No embryo photos = Bad IVF clinic

 


The important of embryo photos in an IVF cycle

 


Many of our patients have done an IVF cycle in another clinic before coming to us, and they are surprised when we tell them that we give photos of embryos routinely to all our patients , because their earlier IVF clinic did not bother to share any information at all – and they did not even know that their embryos could be photographed !

We do this for many reasons.

This is one of the global best practices for all world-class IVF clinics, and we want our patients to be confident that they have received the best possible medical care . Giving them photos of top quality embryos is tangible evidence that we have done this – after all, the only thing an IVF clinic can do is make embryos, and top quality IVF clinics make top quality embryos !

This documentation gives them peace of mind that they haven't left any stone unturned in their quest for a baby . Patients are mature enough to understand that while the outcome of an IVF cycle is uncertain , the process is definitely in the doctor’s hands. By sharing embryo photos , they know that we have carried out the process properly .

Equally importantly , patients will carry these files and show them to other doctors , and these doctors will be able to verify ( after seeing the embryo photos ) that we have provided our patients with top quality medical care . This can be extremely reassuring for the patient.

By being open and transparent , we increase the confidence our patients have in the quality of care we provide them. This is invaluable for us , because it's our patients who are most important source of referrals . We don’t offer any cuts or kickbacks to doctors to refer patients to us , which is why we focus on delighting our patients, so they will refer their friends and relatives to us .

Finally these photos give patients a head-start in starting their Baby Album !

 

 

Friday, April 16, 2021

How to do a Self-Insemination using the Malpani Baby Kit. A Guide for Infertile Couples







We look forward to helping you to have a baby !


 



Bad reporting by IVF clinics when doing a semen analysis - how labs cheat patients

 


This is a great example of the bad reporting which many IVF clinics resort to , in order to increase their work load.

This semen analysis report looks very official because it has been computer printed , and the man is told he has 0% normal forms. This is  labelled teratozoospermia, and the doctor has now diagnosed him as having male factor infertility, and advised IVF/ICSI treatment.

This is very profitable for the IVF clinic, but there is a very high probability that the lab has fudged the figures, because the technician has not bothered to stain the sperm to study their morphology properly. If he had, then the lab would have given an image of the slide of stained sperm, so this could have been verified independently. Staining sperm and studying their morphology take a lot of time and expertise, and most technicians do not have this capability. The fact that this is missing suggests that the technician has been sloppy, and has given a report which is wrong and misleading. Sadly, there is no concept of Quality Control in Indian labs, and they can get away with mis-reporting, because patients are ignorant and clueless, and there is no regulation.

Please don't allow IVF clinics to cheat you !

  

IVF video - How IVF doctors fool their patients - and how IVF patients can protect themselves !


 

The commonest reason for IVF failure

 


The commonest reason for IVF Failure is poor quality embryos , and the commonest reason for poor quality embryos is a poor quality IVF lab.

 The trouble is that patients aren't even aware that their embryos are of poor quality - and this is one of IVF’s  dirty little secrets today - that most IVF clinics in India aren’t capable of creating good quality embryos. They hide this fact by refusing to share information with patients , by hiding the medical records , and not providing photographs of theirembryos to patients.

They do not want to provide tangible documentary evidence of their incompetence – and what makes my blood boil is that they can get away with this arrogance and incompetence because patients aren’t assertive enough to demand their legal rights , and ask for their own medical records ! They have a legal right to these, and it’s illegal on the doctor’s part to hide these, but IVF doctors can merrily continue getting away with cheating patients on a regular basis , because patients are so poorly informed, and they trust their doctors blindly. This can be an expensive error !

When the IVF cycle fails, instead of accepting responsibility for this , the IVF doctor adds insult to injury by blaming the failure on the patient’s poor egg quality , or a thin uterine lining – “facts’ they cook up after the fact, to save their own skin !

The poor patient doesn't know any better , and is forced to accept whatever explanation the IVF clinic gives for the failed implantation. This is why they get taken for a ride .

Even worse, this kind of malpractice harms the reputation of all IVF clinics , because once a patient has burnt their fingers at one IVF clinic , they are very reluctant to trust any other IVF doctor , or take treatment from any other IVF clinic , no matter how good it is .

They have had one bad experience already , and they aren't sophisticated enough to be able to differentiate between a good IVF Clinic and a bad IVF clinic !

This is why you need to do your homework in advance, before starting your IVF cycle !

 

Wednesday, April 07, 2021

How to make sense of your semen analysis report

 This new style of medical reporting is much more patient friendly, and helps patients to understand their test reports.

It will help you interpret your semen analysis report for yourself !

This will save them needless anxiety, and conserve the doctor's time, because he does not need to explain the basics.

https://www.drmalpani.com/pdf/new_semen_analysis_report-foxit.pdf






Tuesday, April 06, 2021

IVF video - IVF success rates for the clinic vs the patient


 

Before you see your IVF doctor

 


It's great see that medical labs are getting digitized, and patients carry their medical reports with them as soft copies on their phone , where they are easily accessible .

However, whenever you go for a consultation with your doctor , please make it a point to print out all your reports and organize them in reverse chronological order .

This helps you to make sure you are well organized, and haven’t forgotten anything.

It’s also much easier for your doctor to review all your reports . If he wants to see a particular report and you can't find it because there's too much garbage on your phone , this makes you uncomfortable , and the doctor starts getting irritated because you're wasting his time .

It’s also a good idea to prepare a one-page piece summary of all your medical treatment , diagnostic procedures , and test results . This gives the doctor a bird’s eye view of what you have been through .

It also shows that you're well organised , so your doctor will respect you more.

Please be proactive in your IVF treatment , because you cannot afford to leave this upto chance.

IVF treatment is expensive , and the outcome is always uncertain, which means you can never be sure how many cycle you will need to get pregnant . After some time, the details of the earlier cycles will start getting blurred, and you don’t want to provide incorrect information to your doctor

 Finally, please do your research, so you can ask the doctor intelligent questions. Seeing how well he answers them will help you select the doctor who is right for you.

 

 

Monday, April 05, 2021

IVF video - why embryo pooling is not always a good idea


 

Poorly informed IVF patients attract bad IVF doctors



Many IVF patients will blame the doctor when their IVF cycle fails .

When I  out point to them that their quality of medical care was poor because the doctor did not even bother to provide them with photos of their embryos, they behave as victims , saying - My doctor cheated me and took me for a ride !

Patients don't want to hear the truth ,because they suffer from the problem of cognitive dissonance . They have already invested a large amount of time and money and energy on a particular doctor , and want to continue with him, because of the powerful forces of inertia.

They don’t want to be told the truth that the doctor was bad , because this reflects poorly on their ability to select a good doctor !

This is why they continue following the bad advice which the bad doctor gives .

This makes no sense to me .

When you learn that you are in the wrong hands and the doctor is taking advantage of your ignorance , why would you continue allowing him to exploit you ?

Bad doctors love poorly informed patients - someone who doesn't bother to ask questions , doesn't bother doing any research , and doesn't bother to take a second opinion , even though there is so much at stake .

It’s can be dangerous to blindly obey everything your doctor says.

If you are lucky enough to find a good doctor , you are fine, but what happens if you don't find a good doctor ?

The reality is there are far more bad IVF doctors than good IVF doctors , and you just can't afford to be passive and leave everything up to the doctor .

It’s important that you be assertive and proactive , so that you can hold your doctor answerable and accountable .

Good doctor are happy when they have good patients , because they know exactly what they're doing and why they are doing it .

The only thing in the doctors control is the IVF process , and not the outcome .

If you are upset and angry and bitter about the fact that your doctor has taken you for a ride please don't continue wasting more time and money and energy in a bad IVF clinic .

Please cut your losses , and find a better doctor.

Don't allow a bad doctor to take advantage of your gullibility - this can be an expensive error

Yes, this does involve a more work , but the fact that you have already been through a failed IVF cycle means you are now much smarter than before you started it , so take advantage of this hard-earned experience !

Better late than never  !

 

Sunday, April 04, 2021

What every IVF patient needs to know before starting IVF - How to find the best IVF clinic

 


Every IVF patient wants to go to the best IVF doctor . After all, it’s obvious that the better your doctor , the better your chances of getting pregnant !

However, the catch is that it's very hard to find out who the best IVF doctor for you is.

Every doctor claims they are the best – after all, no doctor is going to say I am the second-best !

It’s hard for patients to differentiate between IVF doctors , because pretty much every IVF clinic website looks the same .

They all claim they have the best IVF success rates ; they all have photographs of smiling couples and happy babies; their “state of the art” IVF laboratory's facilities ; how experienced and caring their doctors are ; and testimonials by patients of how great their experience has been ( though how many of these have been bought and how any are fake is hard to say, because IVF has become so cut-throat and commercialized today).

It’s only when you actually visit the IVF clinic that you find out that a lot of these claims are just marketing spiel, and that there is a big gap between what the website claims, and what the clinic actually does.

Part of the problem is most patients only learn how to differentiate between good and bad IVF doctors the hard way – after their IVF cycle fails. This is the time they finally wake up , and realise they should have asked lots of questions before paying their fees.

After you have signed up for the IVF package , it becomes very hard to get back out , because doctors are quite happy to take your money up front . They often lure patients into signing up for three cycle IVF packages , which means it’s very hard to leave, because you are trapped. No one wants to waste the money they have spent, and hope lives eternal, so patients fall into the “sunk cost” trap.

Once they sign you up ( by offering a low price up-front, so patients think they are getting a bargain), it’s easy for them to upsell and cross sell you . Once you start your treatment cycle , they add new bells and whistles , which are much more expensive , and patients are tempted, because the doctor claims these additional procedures will increase their chances of getting pregnant. These include duds like the ERA test and PGT.

The poor patient doesn't know any better , and is happy to do whatever the doctor advices, to increase the chances of getting pregnant . They are happy to believe whatever the doctor tells, but the doctor is just adding financial insult to emotional injury .

Patients they find themselves trapped in a hole which they can't get out of .

The only way to protect yourself is to be proactive , and do your homework before you pay your IVF fees

 

Saturday, April 03, 2021

IVF video - the best treatment for repeated IVF failure is TLC !


 

How can I increase my HCG level ? An IVF patient's query

 


 


After the long two week wait ( 2ww), when patients do their HCG level in order to find out whether the IVF cycle has succeeded or not , they go to pieces when the HCG level is negative. One of the commonest questions patients ask is – Is there anything I can do to increase my HCG level ? They don’t want to accept the truth that a negative HCG means their cycle has failed,  because this means all their hopes and money and energy has gone down the drain .

They feel that if the doctor can do something to improve their HCG level , their pregnancy would be fine .

It breaks my heart when patients ask these questions ,because it clearly shows that they don't understand anything about IVF treatment , or how to interpret the HCG level .

This upsets me , because not only does this mean their doctor has not bothered to explain anything to them , it also means that they've been very passive and not done any homework for themselves .

The HCG level is a diagnostic marker for the health of the pregnancy . It is produced by the trophectoderm ( the future placental cells ) of the embryo , which means that there is nothing anyone can do to increase the HCG level . It’s because the pregnancy is not viable that the HCG level is low ! The low HCG level is not the problem – it is the result of an embryo which has failed to implant.

Yes, we can increase your HCG level by giving you an HCG injection , but obviously that is not going to serve any useful purpose .

A negative HCG is a reliable diagnostic marker of the fact that the IVF cycle has failed, and there’s nothing much we can do about it at this stage.

Every embryo has its own biological destiny , and the trouble is that we can only learn what this is two weeks after the embryo transfer , by checking the HCG level .

Before this result, just like the patient is completely clueless , so are we, because the uterus is still a black box area , and we cannot monitor embryo implantation as yet

 

Friday, April 02, 2021

IVF video - Making sense of your HCG levels after your 2ww


 

Common delusions IVF patients suffer from - My IVF doctor is the best !


When I review the records of patients who have taken treatment in other IVF clinics , they often claim that they went to the best doctor in their city – the doctor who is the finest , and is the best IVF expert available.

This is because they need to rationalize the decision that the doctor they selected was the right doctor , even if it is clear from their medical records that the doctor wasn't good because he did not provide high quality medical care . He did not even bother to provide photographs of the embryos he transferred.

There is a lot of emotional discomfort as a result of cognitive dissonance when patients realize they were taken for a ride by their IVF doctor. They kick themselves because they selected a bad doctor because they did not bother to do their research .

Patients don’t like confronting this fact , and what to continue believing that the doctor they chose was the best – after all, they have already spend tons of money in his clinic, and the truth can be hard to accept.

They take offence when I tell them that perhaps the choice they made was not good, and the quality of care which they got was poor.

While I am not saying that I am the best doctor , all I'm saying is that patients need to be aware that there are multiple different options , and each IVF clinic has their pros and cons .

Unless they are proactive and take an active interest in their treatment by questioning the doctor and being assertive , they're not going to be happy with the quality of care they receive – especially if their IVF cycle fails , by which time it’s too late to do anything about this.

 

Thursday, April 01, 2021

IVF Video - when to change your IVF doctor



IVF and alternative medicine - does acupuncture and ayurveda help to improve IVF success rates ?



Patients often ask me whether they should use alternative therapies such as acupuncture,  ayurveda or homeopathy during their IVF treatment .

I have an open mind and am not dogmatic .

I don't feel that Western medicine has all the answers , and am perfectly willing to be flexible.

If patients believe that a certain form of therapy helps them , I encourage them to explore it.

Many of these treatments are not scientifically proven , and therefore I consider them to be empirical therapy - is therapy based on clinical experience .

This is perfectly valid – not all treatment needs to undergo clinical trials , and not all treatment needs to be written about in textbooks for it to be effective .

I do tell them I am not an expert on any of the alternative forms of therapy , and they need to find an expert in that field if they want to explore the option.

If empirical therapy is inexpensive without any side-effects or risks, it makes sense for them to explore it with an open mind.

The reality is none of us has all the answers , and it's not as if modern medicine has a monopoly on medical knowledge.

If doing alternative therapy gives you peace of mind , you should explore it – you have little to lose, especially when it is used to complement IVF treatment

 

Wednesday, March 31, 2021

IVF video - Good IVF clinics vs Bad IVF clinics



Before you see your IVF doctor - practical tips every IVF patients need to know

Since you only have a few minutes to spend with your IVF doctor, it's important to be well-organised, so that you can make the most of your precious time with him.

Do your homework online, so you can ask intelligent questions, tailored to your particular circumstances.

The only stupid question is the one you don't ask !

Here are some practical tips

It's great see that medical labs are getting digitized, and patients carry their medical reports with them as soft copies on their phone , where they are easily accessible. However, whenever you go for a consultation with your doctor , please make it a point to print out all your reports and organize them in reverse chronological order .

This helps you to make sure you are well organized, and haven’t forgotten anything.

It’s also much easier for your doctor to review all your reports . If he wants to see a particular report and you can't find it because there's too much garbage on your phone , this makes you uncomfortable , and the doctor starts getting irritated because you're wasting his time .

It’s also a good idea to prepare a one-page piece summary of all your medical treatment , diagnostic procedures , and test results . This gives the doctor a bird’s eye view of what you have been through .

It also shows that you're well organised , so your doctor will respect you more.

Please be proactive in your IVF treatment , because you cannot afford to leave this upto chance.

IVF treatment is expensive , and the outcome is always uncertain, which means you can never be sure how many cycle you will need to get pregnant . After some time, the details of the earlier cycles will start getting blurred, and you don’t want to provide incorrect information to your doctor .

Finally, please listen to your gut when deciding which doctor to go to. 

The good news is you have lots of choices.

The bad new is you have lots of choices

This is why it can be hard to select who is right for you. Seeing how well your doctor answers your questions will help you select the doctor who is right for you.

 

 


Tuesday, March 30, 2021

IVF video - please do not waste your precious embryos !


 

Why did my IVF cycle fail even though my IVF doctor is the best ?



When I review the records of patients who have taken treatment in other IVF clinics , they often claim that they went to the best doctor in their city – the doctor who is the finest , and is the best IVF expert available.

This is because they need to rationalize the decision that the doctor they selected was the right doctor , even if it is clear from their medical records that the doctor wasn't good because he did not provide high quality medical care . He did not even bother to provide photographs of the embryos he transferred.

There is a lot of emotional discomfort as a result of cognitive dissonance when patients realize they were taken for a ride by their IVF doctor. They kick themselves because they selected a bad doctor because they did not bother to do their research .

Patients don’t like confronting this fact , and what to continue believing that the doctor they chose was the best – after all, they have already spend tons of money in his clinic, and the truth can be hard to accept.

They take offence when I tell them that perhaps the choice they made was not good, and the quality of care which they got was poor.

While I am not saying that I am the best doctor , all I'm saying is that patients need to be aware that there are multiple different options , and each IVF clinic has their pros and cons .

Unless they are proactive and take an active interest in their treatment by questioning the doctor and being assertive , they're not going to be happy with the quality of care they receive – especially if their IVF cycle fails , by which time it’s too late to do anything about this

 

Monday, March 29, 2021

Previous Caesarean section reduces IVF pregnancy rates



Many IVF patients are subjected to a caesarean section by their obstetrician when they get pregnant, because this is considered to be a “precious pregnancy”, even though there is no real medical reason for them not to have a normal vaginal birth.

The problem is that when they come back for their next baby, the IVF success rates drop because of their earlier caesarean section. The scar on the uterus reduces the chances of the embryo implanting.

The risk is increased if a post-Caesarean scar defect (also called a niche) is seen on the ultrasound scan .  A niche is an indentation of the uterine wall of at least 2 mm at the site of the Caesarean scar, assessed by transvaginal ultrasound .  Some of  these patients also have an accumulation of endometrial fluid around the niche.

The reasons for the lower pregnancy rates after a Caesarean section remain to be elucidated. Some studies suggest that incomplete uterine healing and post-operative infection may play a key role in interfering with embryo implantation

Also, implantation very close to or in the niche increases the risk of a miscarriage, because the niche is not a favourable site for implantation.

Please don't allow your doctor to do a routine elective caesarean section for you ! There needs to be a very good medical reason for performing this major surgical procedure !


 

IVF video - How to interpret your HCG blood report


 

Making sense of your HCG blood test report - a guide for IVF patients



One of the most important blood tests for IVF patients is the HCG test .

This is done two weeks after the embryo transfer , to find out whether the embryo implanted or not – and tells us if your IVF was successful or not . Obviously , a lot rides on it , and whenever patients get their report , the first thing they want to know is if it is positive or negative.

Now making sense of the HCG report is extremely easy , because HCG ( for all practical purposes ) is produced only by the placenta during pregnancy . This means if it positive , you are pregnant - and if it is negative , this means you are not pregnant .

However, we find many patients have a hard time interpreting the HCG level , and this is true for multiple reasons .

The first problem is the lab report format, which is very unfriendly. While the report is medically accurate , it’s full of numbers ( for example, the normal ranges during the pregnancy). This makes it hard for patients to know what the expected normal range for them should be, because HCG levels rise so rapidly during pregnancy , and the lab has to include all the ranges when reporting , because it doesn't know how many weeks pregnant the patient is . Patients only care about their value, and often can’t even find this on the report.

Another big problem with interpreting the HCG level is the fact that there is such a wide range of normal values. This is because HCG levels rise exponentially , which means they double every two days , and the level rises from 300 mIU/ml to 1000 mIU/ml in 4 days !

Patients don’t understand this, because they are much more used to interpreting simple blood tests such as blood sugar levels , or hemoglobin levels , which usually remain pretty much stable over time .

A big problem is also that patients are innumerate, and don't understand how to make sense of numbers . For example, they don’t understand decimals, and when the laboratory reports the HCG level as being less than 0.567 ( which means it’s negative because it’s less than 1), they get confused .

Some patients naively believe that negative equals zero, and that the presence of any HCG in their body means that they must be pregnant – after all, how did this HCG show up if they aren’t pregnant ?

The problem is that a negative HCG level causes a lot of frustration and heartache. It’s hard to come to terms with the truth, and patients are very hopeful that if they repeat it again, it may become positive.

The problem is that false hope can be cruel, and if the HCG level ( as done from a reliable lab ) 12 days after the embryo transfer is negative , this means your cycle has failed , and there's no point in wasting money on repeating the test again .

Another major area of confusion is the weeks of pregnancy reported as part of the normal range on the printed area . Patients are confused , and don’t understand the difference between the menstrual age ( as calculated by the duration from the last menstrual period, LMP) vs embryonic age ( the actual age of the embryo).

While a negative HCG is easy to interpret, a positive HCG is harder to decipher, because a single value means little. We need to repeat the test, to ensure it is doubling every 2-3 days, to confirm that the placental cells are growing well, which suggests a healthy, viable pregnancy

 

 

Sunday, March 28, 2021

IVF video - all that glitters is not gold. How to stop wasting your money on the "latest and newest" tests

 


What tests can you do if you have failed multiple IVF cycles ?



 Patients who have failed repeated IVF cycles even though apparently perfect embryos were transferred, are understandably upset, frustrated and distressed. They are looking for answers as to why they are not getting pregnant, and a plausible reason is that their body is "rejecting" their embryos. This is why immune testing for patients with reproductive failure has become very fashionable recently.


Many labs use different protocols to carry out these tests, which are still poorly standardized. This means that results for the same test from different labs vary widely, making interpretation very difficult. 


Also, intelligently interpreting these tests in individual patients is virtually impossible, because of the considerable overlap in the results in normal fertile women and those who are infertile, since many fertile women will also have abnormal results when subjected to these tests. Sadly, most labs do not bother to standardize their test results by doing them on normal fertile women. This means that if a woman who has had an IVF failure is subjected to these tests and has an abnormal result, her doctor happily jumps to the erroneous conclusion that he has now "diagnosed " the reason for the IVF failure, little realizing that the abnormal result could just be a "red herring", since "abnormal " results are often found in "normal " fertile women as well. (These are called " false positives " - test results which are abnormal ('positive'), even though the patient has no disease.) 


The truth is that we can't find the reason why a "perfect IVF cycle" fails because our technology is still not good enough to track the fate of the embryo after it is transferred into the uterus. Embryo implantation is a black box , and is very inefficient.

The problem is that a false positive result causes needless anxiety, and will often lead to a situation in which the patient will have to undergo even more tests to prove or disprove the previous results. Remember that if your doctor performs enough tests on you, it is a mathematical certainty that he will find something wrong with you. And if he finds something wrong with you, he'll usually end up treating you - whether you need treatment or not !
The only person who benefits by doing these expensive and exotic and esoteric tests is your doctor !

Just Say No if she advises them

There is a long list of expensive tests which many labs now perform - and these include: DQ Alpha, Leukocyte Antibody Detection, Reproductive Immunophenotype, ANA (Antinuclear Antibody), Anti-DNA/Histone Antibodies, APA (Antiphospholipid Antibodies), Natural Killer ( NK) Cell Assay , Pregnancy Destruction Factor and TJ6 Protein. This mind -boggling range of catchy acronyms conceals the fact that no one knows whether the immune system is really responsible for the failure of the embryos to implant in these women. Because these tests are unreliable, they are in vogue for a few years, and then die out when doctors realise they don;t add any value.

Saturday, March 27, 2021

IVF success rates and technology - new is not always better and old is often gold !




Like all IVF specialists, we want all our patients to get pregnant in the very first cycle itself . When patients get pregnant, they refer their friends and family members to you – and this is the best source of referrals !

This is why we want to achieve a 100% percent success in IVF , but the problem is that IVF doesn't have a 100% pregnancy rate, and this is a fact we need to learn to live with.

The problem is that false hope is created every time a new scientific advance which is reported as being cutting edge research in described in medical conferences and medical journals. All doctors get excited and want to be the first in India to offer this newest technology. And these researchers also publish press releases to get more publicity, so patients read about the “newest and latest” technique developed in the USA, and want us to use it for them.

However, over time we often find that not everything which glitters is gold , and a lot of the stuff doesn't actually end up working very well in clinical practice .

This is not surprising , because most researchers have a publish or perish mentality , which means they are under a lot of pressure to publish papers, even if their findings are reliable or replicable. Since no one wants to publish negative results , and editors are only interested in publicizing positive results , there is a lot of hype about these “advances”.

These include : the use of growth hormone injections for poor ovarian responders;

  • the use of immune testing and immune therapy for treating recurrent IVF failure;
  • PAMP and ERA tests;
  • Intrauterine infusion of growth factors for improving a thin uterine lining;
  • stem cell ( PRP) therapy;
  • endometrial scratching to improving endometrial receptivity.

 We tried these out when they were first described, and have stopped using them , because they don’t improve IVF success rates.

The tragedy is that many IVF clinics continue selling these techniques to their patients, simply because they can charge more for every additional procedure they do, even though it's been proven that these techniques don't work well .

This is why it's so important that patients be assertive , and do their own homework for themselves rather than signing up for every technique which the IVF clinic offers to you.

You don’t have to become cynical , but you do need to learn to be skeptical.

New is not always better , and older techniques are better because they've stood the test of time.


Friday, March 26, 2021

The best treatment for repeated IVF failure ( recurrent implantation failure) is TLC !



Some of the most frustrating problems in reproductive medicine today are the ones we do not have the technological tools to be able to make an accurate medical diagnosis for, We call them “idiopathic” – which is medical jargon for GOK - God Only Knows.

This is true for the three categories of the most difficult patients IVF specialists see today.

  1. Unexplained infertility , where all the medical tests we do aren’t able to explain why the couple can’t get pregnant in their own bedroom
  2. 2.   Recurrent implantation failure , or repeated IVF failure, where the patient fails to get pregnant in 3 IVF cycles, even though we have transferred top quality blastocysts in a receptive endometrium
  3. 3.  Recurrent pregnancy loss or recurrent abortion , where the patient gets pregnant , but loses the pregnancies every time , at about 6 to 8 weeks , and we not being able to pinpoint the cause.

Now we have a standard medical work up for all these conditions, which means we do an extensive  panel of tests to try come to a diagnosis. The problem is that usually we can’t find any abnormality !

This is the time when truthful doctors will stop, and confess to the patient that we have reached the limits of modern medical knowledge , and are now entering the realm of medical ignorance . Doing more tests will not help, and further testing should only be done by researchers who are doing controlled clinical trials. After all, it is not fair to treat patients in an IVF clinic as guinea pigs .

However, patients are not happy with this answer , and want more tests done – the more, the better ! Doctors are happy to oblige, because these tests are expensive, and very profitable for them to do. Also, doing tests conveys to the patients that they are being “thorough and careful”.

However, the truth is they provide no useful actionable information . What’s even worse is they are plagued by false positive results, which means doctors make patients waste a lot of time and money chasing red herrings.

Ideally, the doctor should be humble and honest,  and explain that there is nothing further medical science can offer them, and we have done everything humanly possible, which should give patients invaluable peace of mind that no stone has been left unturned. After all, medical science has its own limitations .

This doesn’t mean that we are helpless, and there is still hope for the patient – we aren’t writing them off or refusing to treat them.

Going forward, the two most important tools are – patience,  which means we keep on doing this until it works ; and the most important therapeutic ingredient is TLC,  or tender loving care !

This might sound surprising , because TLC doesn't seem to be a medical treatment which anyone could prescribe , but nevertheless it is one which has been proven to be extremely effective ! In fact , it's been shown to be far more effective for patients with recurrent pregnancy loss , as compared to additional experimental treatment options , such as PGT or immunotherapy . And the best thing about TLC is that it’s free !

 

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